Provider Demographics
NPI:1396563011
Name:ROSE MASSAGE THERAPY, LLC
Entity type:Organization
Organization Name:ROSE MASSAGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LMT, CNMT
Authorized Official - Phone:719-821-0377
Mailing Address - Street 1:955 N GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2927
Mailing Address - Country:US
Mailing Address - Phone:719-256-0797
Mailing Address - Fax:719-285-0781
Practice Address - Street 1:955 N GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2927
Practice Address - Country:US
Practice Address - Phone:719-256-0797
Practice Address - Fax:719-285-0781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty